What is a Bunion?

Bunions develop when the joints in your big toe, primarily the first meta-tarso-phalangeal joint (MTP joint), no longer fit together as they should and become enlarged and tender. This condition is apparent when the big toe points toward the other toes and produces a big bump on the inside of your foot at the joint of the big toe. This enlargement or bump is termed bunion.

Causes, Incidence and Risk Factors

In Latin, the word "bunion" means "enlargement." Bunions are the third most common foot problem. It affects about 3% of the population. Females are affected more than males, because they are more likely to wear shoes with pointed toes or high-heels.

Wearing ill-fitting shoes is considered the most common cause for the formation of bunions. Shoes that fit poorly with less space for toes push the big toe toward the middle of the foot. Constant use of such footwear may lead to bunions and associated inflammation of the joint.

Individuals having a family history of bunions may run a greater risk of developing this condition. There are other conditions that may increase the risk of bunions and further hallux valgus.

Risk Factors:

• Joint disease
• Trauma
• Existing structural deformity of the foot
• Abnormal gait

Signs and Symptoms

The patient usually complains of a lump on the meta-tarso-pahalngeal joint of the big toe. This is accompanied by pain, redness and discomfort while walking. The deviation of the big toe may put pressure on the other toes. This may lead to hammer toes. Corns and calluses may also develop.

Screening and Diagnosis

A physical examination and radiographic studies, such as X-rays are essential for the diagnosis of bunions. A standing foot image in antero-posterior (front to back) and lateral (side to side) view is helpful, particularly if surgical interventions are planned.

Laboratory investigations are indicated if any bone disease is suspected.

Treatment

Medical Treatment:

• Wear properly fitting shoes with a broad and deep toe to avoid further pressure.
  
  
• Shoes can be stretched over the bunion to accommodate the changes.
  
  
• Felt padding can be used over the bunions.
  
  
• Physical therapy is recommended to maintain the flexibility of the joint.
  
  
• Foot orthotics (specially designed shoes) may help in slowing the progression of bunions and preventing complications.
  
  
• Night splints may hold the toes in the correct position, while sleeping.
  
  
• NSAIDs can be prescribed to relieve pain and joint inflammation.

Surgical Treatment:

Surgery is done in individuals who have severe deformity and do not benefit from conservative methods. The surgical procedure preformed to remove the bunion is called a bunionectomy. There are many bunionectomy techniques, which include:

• Balancing the tendons around the great toe restores the normal anatomy of affected joint.
  
  
• Osteotomy (cutting the bone) corrects the structural deformity.
  
  
• Resectional arthroplasty is done for the elderly, with degenerative disease.
  
  
• Resectional arthroplasty with implant. Arthroplasty refers to the removal of bone from the joint and the placement of an implant.
  
  
• First meta-tarso-phalangeal joint arthrodesis is an option for patients with a high-activity level. This is where the big toe joint is fused in place.

Recovery

Generally, bunions can be treated successfully, reducing the foot pain associated with them. The treatment plan and outcome depends largely on the severity of the bunion, the age of the patient, and the patient's activity level.

Complications:

• Infection introduced to the joint during surgery
• Bone deformity
• Ongoing pain

Prevention

The best way to prevent getting bunions is by wearing shoes that fit properly. If you notice a bunion forming on your foot, selecting the proper footwear can keep the bunion from getting worse.